Report of an outbreak of enterovirus disease in a neonatal intensive care unit and a systematic review of the literature

Nathan L'Etoile; Lindsay Brim; Susan Coffin; Ericka Hayes; Nathan L'Etoile; Lindsay Brim; Susan Coffin; Ericka Hayes

doi:10.3934/microbiol.2025009

AIMS Microbiology

2025, Volume 11, Issue 1: 167-181. doi: 10.3934/microbiol.2025009

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Review

Report of an outbreak of enterovirus disease in a neonatal intensive care unit and a systematic review of the literature

1.
Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
2.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
3.
Department of Infection Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

Received: 04 October 2024 Revised: 07 February 2025 Accepted: 24 February 2025 Published: 28 February 2025

Neonatal enterovirus infections have the potential to cause devastating illness and death in this vulnerable age group. Existing evidence suggests that the incidence of enteroviral infections in the post-natal period may be higher than previously thought. Because neonates infected with enterovirus are at risk of severe sequelae, and healthcare-associated outbreaks in neonatal settings can occur, enteroviral infection in hospitalized neonates is a serious concern. Thus, it is essential to conduct surveillance for these infections and to deploy robust infection control measures once the virus has been detected in a neonatal care setting. Here, we report an outbreak of enterovirus in a neonatal intensive care unit (NICU) that was rapidly identified and contained, resulting in relatively few cases but requiring temporary closure of the unit. Additionally, we present our review of the literature describing the characteristics of enteroviral outbreaks in NICU and nursery settings to compare published outcomes of outbreaks to those of our outcome.
- enterovirus,
- outbreak,
- neonates,
- infection prevention,
- healthcare-associated
Citation: Nathan L'Etoile, Lindsay Brim, Susan Coffin, Ericka Hayes. Report of an outbreak of enterovirus disease in a neonatal intensive care unit and a systematic review of the literature[J]. AIMS Microbiology, 2025, 11(1): 167-181. doi: 10.3934/microbiol.2025009

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Abstract

Neonatal enterovirus infections have the potential to cause devastating illness and death in this vulnerable age group. Existing evidence suggests that the incidence of enteroviral infections in the post-natal period may be higher than previously thought. Because neonates infected with enterovirus are at risk of severe sequelae, and healthcare-associated outbreaks in neonatal settings can occur, enteroviral infection in hospitalized neonates is a serious concern. Thus, it is essential to conduct surveillance for these infections and to deploy robust infection control measures once the virus has been detected in a neonatal care setting. Here, we report an outbreak of enterovirus in a neonatal intensive care unit (NICU) that was rapidly identified and contained, resulting in relatively few cases but requiring temporary closure of the unit. Additionally, we present our review of the literature describing the characteristics of enteroviral outbreaks in NICU and nursery settings to compare published outcomes of outbreaks to those of our outcome.

HFMD

Hand-foot-and-mouth disease

IPC

Infection prevention and control

IVIG

Intravenous immune globulin

NICU

Neonatal intensive care unit

ORION

Outbreak Reports and Intervention Studies of Nosocomial Infection

PCR

Polymerase chain reaction

PPE

Personal protective equipment

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Acknowledgments

We would like to thank the Infection Prevention Department at the Children's Hospital of Philadelphia for their input and support of this investigation and review. We would especially like to thank Jordan Mick, who provided information regarding unit characteristics and the outbreak investigation.
NL was funded by a T32 training grant (T32AI055435) while editing this manuscript.

Conflict of interest

The authors declare no conflict of interest.

Author contributions

NL collected information regarding the outbreak from infection prevention records and medical records, performed the systematic review, and drafted the manuscript. LB provided information regarding the outbreak and reviewed the manuscript. SC and EH both revised the manuscript and oversaw the drafting.

References

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